Therapeutic issues in transplant patients

Patients who have undergone previous organ transplantation represent a considerable therapeutic challenge to the anaesthetist. Although a transplant may have restored normal or near-normal function for that organ, the original underlying pathology often persists. In addition, undesirable effects of immunosuppressant drugs, particularly calcineurin inhibitors, may give rise to damage to other organs and organ systems. Diabetes, hyperlipidaemia and accelerated vascular and renal damage are a common feature. The majority of post-transplant patients require treatment for these phenomena. Common medications include statins, antihypertensives and sometimes prophylaxis against nosocomial infection. When managing post-transplant patients, both drugs and pathology have to be taken into account. Non-steroidal anti-inflammatory drugs pose a particular hazard.